Please use this identifier to cite or link to this item: https://doi.org/10.1093/jac/dkab009
Title: Cefazolin versus ceftriaxone as definitive treatment for Klebsiella pneumoniae bacteraemia: a retrospective multicentre study in Singapore
Authors: Lee, I Russel 
Tun-Linn, Thein
Ang, Li Wei
Ding, Ying 
Lim, Jonathan J
Bok, Chwee Fang
Mukherjee, Shilpa
Titin, Christina
Kalimuddin, Shirin 
Archuleta, Sophia 
Lye, David C 
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Microbiology
Pharmacology & Pharmacy
BETA-LACTAMASES
THERAPY
IMPACT
EPIDEMIOLOGY
REGRESSION
INFECTION
MORTALITY
SURVIVAL
Issue Date: 27-Jan-2021
Publisher: OXFORD UNIV PRESS
Citation: Lee, I Russel, Tun-Linn, Thein, Ang, Li Wei, Ding, Ying, Lim, Jonathan J, Bok, Chwee Fang, Mukherjee, Shilpa, Titin, Christina, Kalimuddin, Shirin, Archuleta, Sophia, Lye, David C (2021-01-27). Cefazolin versus ceftriaxone as definitive treatment for Klebsiella pneumoniae bacteraemia: a retrospective multicentre study in Singapore. JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 76 (5) : 1303-1310. ScholarBank@NUS Repository. https://doi.org/10.1093/jac/dkab009
Abstract: Background: Ceftriaxone is the preferred treatment for bacteraemia caused by non-MDR (antibiotic-susceptible) Klebsiella pneumoniae. Excessive and widespread ceftriaxone use creates selection pressure for ESBLs. Cefazolin is an alternative, although there are theoretical concerns that SHV-1 β-lactamase in K. pneumoniae may inactivate cefazolin in an inoculum-dependent manner. Objectives: In this retrospective study, we investigated the outcomes in K. pneumoniae bacteraemia patients treated with IV cefazolin versus IV ceftriaxone as definitive therapy. Methods: A total of 917 patients infected with K. pneumoniae from 1 January to 31 December 2016 in three public acute care hospitals in Singapore were screened for study eligibility. Consecutive unique episodes of monomicrobial bacteraemia caused by cefazolin-And/or ceftriaxone-susceptible K. pneumoniae were analysed (n = 284). Results: There were 143 patients (50.4%) in the cefazolin group and 141 patients (49.6%) in the ceftriaxone group. Demographics, baseline illness severity and risk factors for healthcare-Associated bacteraemia were comparable in the two treatment groups. The primary outcome of 28 day all-cause mortality was not significantly different between the cefazolin and ceftriaxone groups (10.5% versus 7.1%, P = 0.403). Both in the crude analysis and using a multivariable logistic regression model with inverse probability weighting based on propensity score, cefazolin treatment was not associated with increased risk of 28 day mortality (OR 1.51 with ceftriaxone as the reference group, 95% CI 0.67-3.53; adjusted OR 1.55, 95% CI 0.33-7.40). Conclusions: Cefazolin may be a ceftriaxone-sparing alternative treatment for antibiotic-susceptible K. pneumoniae bacteraemia. This observation may provide sufficient clinical equipoise for a randomized controlled trial.
Source Title: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
URI: https://scholarbank.nus.edu.sg/handle/10635/234522
ISSN: 0305-7453
1460-2091
DOI: 10.1093/jac/dkab009
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